Medical Innovation: The Issues

Medical staff in MSF field programmes are all too often unable to give the best medical care they could wish, because the resources at their disposal are outdated, ill-adapted or ineffective. There have been almost no new drugs developed to treat tuberculosis for over 40 years and there is no test widely available to diagnose infants that have HIV/AIDS in poor countries, for example. This is because medical innovation - the development of new drugs, diagnostics and vaccines - is overwhelmingly steered towards products that will give commercial rewards and not towards the greatest medical needs.

Global spending on health research is skewed towards wealthy markets, while many of the health priorities of people in the developing world are neglected. In other words, medical innovation is steered towards drugs, diagnostics and vaccines that give the biggest commercial rewards and not the greatest therapeutic benefits. This is a result of the current system of product development that relies on charging high prices for the final product in order to recoup the costs of R&D. More generally, overall funding for innovation that addresses the diseases of people in poor countries remains grossly insufficient.

There are gaping holes in medical innovation that urgently need to be filled. Drugs, vaccines and diagnostics that cater to children suffering from diseases that predominantly affect the developing world are drastically under-researched. There are very few drugs suitable to treat children with HIV/AIDS; there is still no simple nor effective way to diagnose an infant with HIV or TB. Other problems include that many health tools aren’t adapted for use in resource-limited settings, requiring refrigeration for example; and for diseases such as chagas, kala azar and sleeping sickness are so neglected that existing treatments fall far short of what is needed.

Today, when medical innovation occurs, it often leads to expensive products, as pharmaceutical companies who research and develop these new drugs and diagnostics recoup their investments by charging high prices. Often this means preventing, thanks to patent-protected monopolies, more affordable generics from being produced. These issues have sparked calls for change. At the World Health Organization, an intergovernmental process is underway to look at these issues.

Because relying solely on patents to stimulate medical innovation fails to address the health needs of the world’s poor, other alternative mechanisms are needed. But some mechanisms are more ambitious than others. Product development partnerships like the Drugs for Neglected Diseases initiative have had some success. The Advance Market Commitment for pneumococcal vaccines is more controversial. Particularly promising are mechanisms – such as prize funds - that delink the cost of research from the price of the product.